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Recent advances in the identification of patients at risk of ventricular tachyarrhythmias: role of ventricular late potentials.

Circulation (Impact Factor: 14.95). 07/1987; 75(6):1091-6. DOI: 10.1161/01.CIR.75.6.1091
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    ABSTRACT: Every hour 8 to 10 Mexicans die because of cardiovascular diseases. The most common pathology is Myocardial Infarction, primarily responsible for deaths throughout of the country, and the leading cause of death in the Baja California state. Those who survive a myocardial infarction are highly likely to suffer Sudden Cardiac Death (SCD) due to the development of malignant ventricular tachycardia. This can be predicted with the detection of so- called Ventricular Late Potentials (VLP) located at the end of the QRS complex and/or at the beginning of the ST segment. The Health Sector in Baja California does not have diagnostic assessment devices that can predict these abnormalities. This document details the progress achieved in the development of a technological package (digital and analog interface for USB communication) capable of capturing, recording and analyzing High-Resolution Electrocardiogram (HRECG). The aim is to predict risk of SCD detecting VLP in infarcted patients in our region using the Classical Time Domain Method and the high resolution electrocardiograph device developed in our lab.
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    ABSTRACT: Background and Objectives: The aims of this study were to assess the long term overall survival of patients after an acute myocardial infarction (AMI), and to determine the association of survival with the occurrence of ventricular arrhythmia, as recorded by Holter electrocardiography (ECG) and signal-averaged electrocardiography (SAECG). Subjects and Methods: One hundred fifty two patients with an AMI were enrolled between January 2000 and August 2006. SAECG and Holter ECG were performed before hospital discharge (at range of 2-10 day). The grading system of Lown was used to evaluate the ventricular premature beats on Holter ECG. Three groups of patients were identified based on the seriousness of the ventricular arrhythmia, as identified by the Holter ECG: Lown grade 0, Lown grades 1, 2 and Lown grades 3, 4, 5. SAECG was performed with a high pass frequency of 25 Hz and 40 Hz. The presence of late potentials (LPs) recorded on SAECG was evaluated. The predictors for survival were assessed using Cox's proportional hazard model and Kaplan-Meier analysis. Results: The mean duration of follow-up was 45.8±25.5 months. Twenty four patients (15.8%) died during follow-up. The multivariate predictors of all cause death included age [hazard ratio (HR)=1.25, 95% confidence interval (CI)=1.08-1.47, p=0.003] and Lown grades 3, 4 and 5 (HR=19.17, 95% CI=1.25-290.80, p=0.034). Survival analysis did not show a significant rela-tionship between LPs and overall patient survival. The only predictors for overall mortality were age and the Lown grade. Conclusion: SAECG did not predict mortality for the patient with AMI. The ventricular arrhythmias recorded by conventional Holter before hospital discharge may be a useful noninvasive prognostic test after an AMI.
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    ABSTRACT: Patients with chronic heart failure show a high incidence of complex ventricular ectopic activity and high mortality, with an average sudden death rate of 46%. Given the close relationship between ventricular ectopic activity and left ventricular function, it is difficult to determine whether the ventricular ectopic activity has independent prognostic significance in patients with chronic heart failure. Notwithstanding, several large scale clinical studies have shown that left ventricular dysfunction is the first independent prognostic index in patients with ischaemic or dilative idiopathic cardiomyopathy. Therefore, potentially reversible causes of arrhythmia should be diagnosed and if necessary corrected. Electrophysiological testing and noninvasive techniques are used for evaluating arrhythmia mechanisms and establishing drug efficacy. Empirical therapy of potentially malignant ventricular arrhythmias in patients with ischaemic or dilative idiopathic cardiomyopathy has proved unsatisfactory because of both the inadequate control obtained and the increasing evidence that antiarrhythmic drugs are arrhythmogenic. In selected groups of patients, however, empirical therapy with amiodarone may reduce the frequency and complexity of the ventricular ectopic activity and incidence of sudden death. The use of drugs with an indirect antiarrhythmic action, such as β-blockers and angiotensin converting enzyme (ACE) inhibitors, has been shown to decrease the mortality and incidence of sudden cardiac death in some groups of patients with chronic heart failure. A further step forward in the treatment of patients at high risk of sudden death is represented by nonpharmacological therapy, i.e. excision of aneurysm, surgical or electrical ablation of arrhythmogenic foci, and use of automatic implantable cardioverter defibrillators.
    03/1993; 5(3). DOI:10.1007/BF03258439

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